1. 1 CQC’s new approach to inspecting GP practices & what this means for you Linda Hirst Inspection Manager Primary Medical Services and Integrated Care Directorate.

2. 2 About CQC Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care. Our principles We put people who use services at the centre of our work. We are independent, rigorous, fair and consistent. We have an open and accessible culture. We work in partnership across the health and social care system. We are committed to being a high performing organisation and apply the same standards of continuous improvement to ourselves that we expect of others. We promote equality, diversity and human rights. Types of Inspection Scheduled, Responsive, Themed

3. 3 Our new approach and why we changed We changed in response to the findings of public enquiries. We consulted widely about what our new approach should look like. We have radically restructured. We now have three directorates We have completely changed the way we monitor, regulate and inspect We use intelligent monitoring to decide when, where and what to inspect, including listening better to people’s experiences of care When we inspect we will answer the following questions Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

4. 4 Our new approach We will use the information we gather on inspections to help us rate the quality of the service and we will publish this rating to enable people using services to make informed decisions about health and social care services. We will publish ratings on GP services from October 2014 continuing until April 2016. The ratings are: Outstanding Good Requires Improvement Inadequate Services receiving a rating of requires improvement or inadequate will usually result in a regulatory response and more frequent inspections. They will not all be announced. New legislation and Regulations to underpin our approach are at an advanced stage.

5. 5 How we inspect Inspections of a number of practices carried out in a CCG area over a 2-4 week period. We will visit each CCG and inspect a quarter of practices in that area each time we visit. We will meet with Area Teams and CCGs before and after inspections of practices in the area. We will gather intelligence about the practice, the health information profile of the CCG and will look at intelligence from QOF data (if available), patient survey data, comments and ratings on NHS Choices, intelligence from NHS England. We will look at the practice website (if available). We will take account of direct concerns and complaints received from patients, information from whistleblowers, information from stakeholders and professional bodies (GMC, NMC, HPC). We will use information from listening events and from other directorates to identify any information of good practice or areas of concern. We will use this information to target and plan our inspections. We will announce our comprehensive inspections in advance and will be in touch to explain our inspection, who will be part of the inspection team, the process we will follow and to answer any initial questions you may have.

6. 6 How we inspect When their planning is completed and signed off by their inspection manager, our inspectors will supply you with a proposed timetable for the day. Posters and comment cards will be sent to the practice. You will be asked to provide information before the inspection and to do a presentation to the inspection team on the day. They will negotiate an arrival time (usually ahead of practice opening to enable questions). We will have a specialist inspection team which will comprise one or more inspectors from CQC, a GP advisor, a practice manager advisor and on occasion an expert by experience or a pharmacist inspector (if you are a dispensing practice). The inspection team will always Speak to patients – it is helpful (if possible) to have a private room to facilitate this. Observe interactions between practice staff and patients – this will NOT involve sitting in on patient consultations unless there is a very good reason for this and the patient agrees. Speak to a range of practice staff (all designations) – think in advance how you can facilitate this.

7. 7 How we inspect Inspect the practice in respect of; cleanliness and infection control, safety of premises, safety of equipment, confidentiality of patient records, safety of medicines and prescribing practices. Think about these areas and be prepared for questions, to be asked for audits and action plans. We may look at patient records if there is a specific need to do this – this will usually be because we have highlighted a risk to patients. We will ask our GP advisor or an inspector will do this. We will never ask an expert by experience to look at patient records. We have published guidance on this issue. We will ask you to arrange for us to meet/have a telephone discussion with members of your PPG (if you have one). If not be prepared to answer questions about how your practice obtains the views of patients and uses these to arrive at a decision about the quality of patient care and service. If your practice has more than one branch we may visit other branches. We will ask about your clinical audits and will want to see a sample of these.

8. 8 How we inspect We will always look at services at a location (GP practice) level through the lens of six patient groups. For every NHS GP practice we will look at the quality of care for the following key patient groups: Older people (over 75s) People with long term conditions Mothers, babies, children & young people Working age population and those recently retired People whose circumstances may make them vulnerable (E.g. homeless people, people with drug or alcohol dependency, sex workers, travellers, people with learning disabilities. This is not an exhaustive list) People experiencing a mental health problem Think about what your service provides and elements of outstanding practice and be prepared to let us know about this.

9. 9 How we inspect Expect inspections to last the whole day or in large practices or where there are complex issues possibly two days. The inspection team will provide headline feedback at the end of each inspection. They will not be able to tell you your quality rating. If there is any evidence of immediate risk to patients this will be brought to your attention on the day. You will receive a draft report and you have 10 days to comment on factual accuracy only. You will receive a response if you make factual accuracy comments with the final report. The report will then be published

10. 10 Top Tips for Inspections We will still inspect against the current Health and Social Care Act 2008 and Regulated Activities Regulations 2010 until the Care Bill 2014 is enacted. The current Guidance About Compliance will help you to interpret the Regulations. Be aware of and have read these key documents and think about how your service ensures these are being met Know your service and tell the inspection team about it, providing evidence of this. We must corroborate our findings. Tell us what you do well and also what needs to improve and crucially what you are doing to improve it. Remember it is your legal obligation to identify, assess and manage risks. Think about how you manage risks at a patient and practice level. Ensure your staff relax and are honest. We do not expect perfection, but we expect you to strive for improvement and to ensure patients are protected from harm and receive a good quality, responsive and caring service. We will ask a lot of questions, some will be quite searching, we are looking at the impact of what you do on patient care and welfare. If we set requirements, make sure you send in SMART action plans within the timescales set. It is an offence not to! Make sure the registration of your service is right!

11. 11 Links to useful information Our website www.cqc.org.uk Notifications http://www.cqc.org.uk/content/notifications-gp-providers Making changes to your registration http://www.cqc.org.uk/content/application-form-finder About our inspections http://www.cqc.org.uk/sites/default/files/20141008_gp_practices_and_ooh_provider_hand book_main_final.pdf http://www.cqc.org.uk/sites/default/files/20141008_gp_practices_and_ooh_provider_hand book_appendices_final.pdf

12. 12 References Guidance about compliance http://www.cqc.org.uk/sites/default/files/documents/guidance_about_compliance_summary. pdf Health and Social Care Act 2008 Regulated Activities Regulations 2010 http://www.cqc.org.uk/sites/default/files/documents/health_and_social_care_act_2008_reg ulated_activities.pdf

13. 13 Thank you for listening Any questions?